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I am often asked, “What’s the difference between acupuncture and dry needling?” So, I thought I’d answer the question for everyone in our community who might be interested, and offer some history and science along the way.
“Dry needling” is a term that has grown tremendously in usage over the past decade because it’s a newly adopted practice by many physical therapists. It essentially consists of inserting acupuncture needles into tight muscles. In many states, acupuncturists have fought physical therapists’ attempts to expand their scope of practice to include this procedure. However, physical therapists outnumber acupuncturists by about seven to one, which means stronger state organizations and greater legal power.
Acupuncturists argue that physical therapists are essentially stealing their medicine and calling it something different. In some states physical therapists can practice dry needling with no training in it; in others they typically complete a 55-hour course. By comparison, a licensed acupuncturist generally receives about 500 hours of instruction in the acupuncture-specific portion of their training.
For a few centuries in the West and a couple millennia in China, observers of the human body have known about nodules that occur in tight muscles and are associated with chronic, complex pain patterns. You might just call them “knots.” In the mid-1900s a doctor named Janet Travell coined the term myofascial trigger point to describe this phenomenon. About 90% of them are found at the locations of acupuncture points, which were mapped out on bronze statues at least 1,000 years B.C.E.
Travell explained that myofascial trigger points are irritable regions in our connective tissue (muscle and fascia) that get stuck in a contracted state. They make muscle fibers taut, reducing muscle strength and range of motion, and causing pain, numbness, and other symptoms that often spread to areas far from where they originate. In many cases, what we perceive to be a visceral problem (heart attack, ulcer, migraine, irritable bowel, urinary tract infection, etc.) is actually the symptom of one or more trigger points. I believe trigger points are responsible for most of the physical pain humans experience.
Travell and her colleague David Simons went on to chart the locations and symptoms of trigger points in every major muscle. Travell became John F. Kennedy’s doctor (the first female presidential physician) and his family credited her with saving Kennedy’s political career by curing his back pain through the release of myofascial trigger points.
Travell (and researchers before her) discovered that it’s possible to release a trigger point through a simple procedure she called “ischemic compression.” It basically entails pressing firmly on the center of a trigger point for about half a minute until it softens. Travell’s maps and manual techniques for releasing trigger points were adopted by physical therapists over the following decades. (For what it’s worth, body workers have probably been doing ischemic compression for ages, without calling it ischemic compression.)
Travell also found that she was able to release trigger points by injecting them with numbing agents or saline. However, it emerged that the most effective aspect of this practice wasn’t the injection of fluid, but the mechanical act of probing at the trigger point with a needle. That is, a release could be accomplished even with a “dry” needle, without injecting anything.
Based on this new expression, one could say that all acupuncture is “dry needling.” This is precisely what acupuncturists have always done, although the insertion of needles into these local epicenters of pain is generally just one aspect of an effective acupuncture treatment. What makes an acupuncture treatment holistic (i.e., addressing the whole person) is that the treatment also addresses the underlying mechanisms that led to the surface issue (e.g., stress, diet, digestive problems, more global structural or energetic imbalances, etc.).
In the 1980s, an osteopath and acupuncturist named Mark Seem, founder of Tri-State Acupuncture College in New York City, began integrating Travell’s trigger point maps into traditional acupuncture. He met with Travell and demonstrated his approach. Travell immediately recognized the value of using a much thinner, solid, and springy acupuncture needle (which has a cone-shaped tip), as compared to the hypodermic needles she had been using (which have a scalpel-like hollow beveled tip).
Over the following decades, physical therapists gradually discovered that “dry needling” with acupuncture needles is often a faster and more effective trigger point release method as compared to the various forms of pressure, friction, stretching, exercise, and structural education that have been part of the physical therapists’ palette for their hundred-ish year history. In court cases between acupuncturists and physical therapists, PTs often argue that the insertion of needles into trigger points is a simply an extension of these “manual therapies” described in their scope of practice, and the decision comes down to whether or not the judge agrees.
The other common argument by PTs is that there are many differences between dry needling and acupuncture. In my opinion, having observed PTs doing dry needling and having studied many styles of acupuncture, there’s clear evidence that acupuncturists have been doing everything encompassed in dry needling for a very long time. PTs have insisted that because they know nothing of the acupuncture meridians (energy circuits along which acupuncture points are located), dry needling therefore isn’t acupuncture. But this is like saying that because you haven’t studied anatomy, when you cut into someone with a scalpel you’re not actually doing surgery. Further, there are many systems of acupuncture, several of which don’t utilize meridians.
Enough about the arguments. My purpose isn’t to determine whether or not it’s right for physical therapists to do dry needling, but to clarify the differences in the consumer’s experience.
While acupuncture is great for pain, not all acupuncturists are pain specialists, and most acupuncturists don’t specifically target the trigger points mapped by Travell. If that’s what you’re looking for, it may be worth seeking out an acupuncturist who specializes in pain. Or you might be happy with a skilled physical therapist who does dry needling.
Both acupuncturists and physical therapists run the spectrum from mediocre to brilliantly talented. I have no doubt that there are some masterful PTs out there who get great results doing acupuncture (dry needling) – perhaps better for structural issues than an average-level acupuncturist. I have had patients ask me to “fix” them after a painful dry needling session from a PT that worsened their condition, and I’ve had other patients report good results from dry needling.
If you are skittish about needles, you may not enjoy dry needling from a physical therapist, since it tends to be more intense than the average acupuncture treatment. That said, any form of acupuncture that specifically focuses on releasing trigger points is unlikely to be painless. Regardless of the style of acupuncture I’m performing, I always tell my patients I’m not the person to see if they don’t want to feel anything; I believe a certain degree of sensation is productive.
If you’re someone who cares about how much training your practitioner has received, perhaps it’s meaningful to you that an acupuncturist typically spends ten times as many hours learning their craft than a physical therapist spends learning dry needling. (And virtually all of the acupuncturist’s continuing education will be in acupuncture as well.)
If your primary concern is having your treatments covered by insurance, you’re more likely to get this from a physical therapist. There are some acupuncturists who bill insurance, but more often it will be up to you to submit your receipts and hope for reimbursement.
If it’s important to you that your treatment gets to the root and addresses the whole you, including non-structural issues, you’ll probably be more satisfied with treatment from an acupuncturist. The common experience of “going to acu-land” as some of my patients call it – i.e., becoming deeply relaxed or even having a transcendent experience – isn’t part of the dry needling session. Some would consider the peaceful effect of acupuncture merely a pleasant bonus, but I believe it’s often much more instrumental in the overall outcome than people realize. How often do we stop, rest, and drop all of our concerns? It can be akin to the benefit of a session of deep meditation. The alleviation of stress and a nervous system “reset” is no small thing, especially when stress is the root cause of so much pain.
That said, I find that many patients honestly aren’t concerned with a holistic treatment, and that’s fine. They want a practitioner who will get right into the painful area and work the hell out of it. It might be intense and they might feel beat up afterwards, but there’s a time and place for this kind of work if it’s effective. Personally, I don’t mind receiving aggressive treatments. Occasionally they’ve been miraculous (other times they’ve left me temporarily crippled with no relief). And of course, if the pain itself is one’s primary stressor, one could argue that getting rid of the pain should be a higher priority than alleviating stress (though we don’t have to choose one or the other). In my experience it’s a slight minority of acupuncturists who work this way, while it’s quite common for a physical therapist.
Whew! That was a long-winded exploration of this topic. I thought about removing parts of this article to shorten it, but having had this conversation so many times, I’ve found that many people are curious about all the facets of this subject. I hope I offered some clarity.
Be well,
Dr. Peter Borten
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One of the earliest inspirations that prompted me to go into medicine was a book called The Science of Homeopathy by George Vithoulkas. Of all the many modalities of mainstream and alternative medicine, few are as widely used – or criticized – as homeopathy.
Most other medical systems are heteropathic or allopathic in their approach. Hetero means other or different, allo means opposite, and pathy means suffering or disease. So, both terms mean producing a condition that is incompatible with or antagonistic to the disease process. Today many people use the term “allopathic” in a negative sense to describe mainstream medicine, but if you take an anti-inflammatory herb such as turmeric for inflammation, or an antibacterial such as garlic for an infection, this is allopathic medicine.
Homeopathy is based on the idea that if a particular substance produces a certain reaction (e.g., ipecacuanha causes nausea and vomiting), minuscule quantities of that substance can treat that condition (e.g., homeopathic ipecacuanha alleviates nausea and vomiting). Homeo means like, so homeopathy means “like the disease” and it’s based on the principle that “like treats like.” Some other examples are the use of homeopathic coffee (Coffea cruda) to treat insomnia and agitation, homeopathic onion (Allium cepa) for red and watery eyes and nose, and homeopathic bee venom (Apis) for stings, swellings, and inflammation.
For what it’s worth, not all remedies work this way. In many cases, homeopathic preparations do the same thing the original substance does. The remedy Chamomilla, for instance, is homeopathic chamomile, and like the herb, it is used for digestive and emotional upset. Sometimes homeopathic versions are safer, gentler, more potent, or have a broader range of application. In the case of Chamomilla, it’s also used for teething, ear pain, and menstrual discomfort.
Homeopathic remedies are created through numerous successive dilutions of herbs, minerals, animal parts and occasionally other substances. When the original substance is diluted in ten parts of a solvent (water or alcohol), this is called an X dilution (X being the Roman numeral for ten). When the substance is diluted in one hundred parts of a solvent, this is a C dilution (C being the Roman numeral for hundred). Each time a dilution is made it is shaken in a specific way to transfer the substance to the solvent, and each successive dilution, though chemically weaker, is considered energetically more potent. I made this chart to explain the process:
Many homeopathic remedies are made from highly toxic substances, like arsenic or deadly nightshade. In these cases, the original substance is so highly diluted that the amount of toxin in a resulting pill or tincture is infinitesimal. Often, it’s unlikely that there is even a single molecule of the original substance in the resulting medicine. This is precisely why opponents of homeopathy argue that it’s worthless and call it pseudoscience.
As a scientist, I completely understand this stance, but in my opinion, what occurs in the preparation of a homeopathic remedy is something we don’t yet have the science to explain. I believe the substance leaves some kind of energetic imprint on the solvent it is diluted in. We know from Masaru Emoto’s research on water that various substances and even human intention are capable of leaving a lasting mark on water molecules that’s evidenced in the different forms of ice crystals it forms when frozen. I believe a similar process occurs through diluting and shaking a substance in water, even when the substance is eventually removed.
I must admit, my own experience with homeopathy has been hit-or-miss. I’ve taken numerous remedies that did nothing perceptible. As to whether I chose the wrong remedy or it wasn’t medicinally effective, I’ll never know. But I have also had cases in which homeopathics were remarkably effective.
This has been especially true with babies and animals, and these are cases we could assume are relatively free from the influence of the placebo effect since the recipients are presumably unaware that they’re getting medicine. In particular, I have repeatedly had the experience of giving homeopathic teething tablets to babies that were inconsolable, and within minutes they were peaceful and sleepy. As a parent, I don’t care what the mechanism is as long as it’s safe and it works.
The safety factor is significant, particularly for children, pregnant women, and elderly or frail people. Not only are homeopathics virtually free of side effects, they also tend to have zero “load” on the system. That is, they don’t make you feel like you’re on a drug. Sometimes this may come at the expense of strength (e.g., homeopathic Chamomilla doesn’t approach the potency of Xanax), but there are cases when the top priority is a clean experience. I find this to be especially true in anxiety, when making someone feel drugged can occasionally intensify the anxiety.
Have you tried homeopathy? What did you think? Share with us in the comments section. I would love to hear about your experience.
Be well,
Dr. Peter Borten
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I recently came across this statement on the U.S. Department of Agriculture website: “About 90% of Americans do not get enough dairy.”1 A review of dairy consumption by country shows that the United States ranks 17th in the world with an average intake of 560 pounds per person per year.2 In comparison, the average Japanese person consumes about 158 pounds annually, ranking Japan 109th on this list. Meanwhile, Japan ranks first in the world for life expectancy. The United States is 54th.3 If a country that consumes 28% as much dairy as we do outlives us by an average of eight years, is it accurate to say, “90% of Americans don’t get enough dairy”? Who defines “enough”?
It's questions like these that inspired me to create a new kind of course in nutrition – one that teaches people how to think critically, listen to their bodies, and develop a healthy relationship with food. In How to Eat, I explain how to achieve your optimal weight without counting calories or eating in a totally unnatural way. I lead students to a way of eating that promotes abundant energy and a clear mind without having to wade through all the contradictory information out there. Through a combination of modern science, psychology, and a strong foundation in traditional Eastern systems of medicine, I’ll teach you that it’s not just what you eat, but how you eat that matters.
For today I want to offer you just one simple piece of nutrition advice: stay conscious while eating.
We all tend to think about things other than the act we’re currently engaged in, and this is an especially bad habit while eating. We daydream, we work, we read, we watch TV, we talk, we drive, we play on our phone. This causes us to miss out on many of the benefits of eating, and it also makes us more likely to eat in ways that aren’t healthy.
There are three good things that happen when we stay conscious (i.e., mindful):
- The eating process tends to work better. We're relaxed, we consume at a healthier pace, the body assimilates it better, and I believe we probably derive more nutritional value from the food.
- We notice and can respond to the subtle (or not-so-subtle) messages our body is giving us, such as, “I’m not hungry anymore” or “This food is not compatible with me” or “Slow down.” You can learn virtually everything you need to know about how to best feed yourself – both the specific foods and the ideal time and manner to eat them – just by giving all of your attention to the act of eating.
- We have an amazing opportunity. Truly. I believe that most people may never experience just how profound the act of eating is. This profundity is only available when we give it our full attention. Then we start to get an inkling of it . . .
. . . the complexity of colors, textures, flavors, and nutrients in the food
. . . the incredible sophistication and intelligence of the human body; its ability to extract what it needs from the food and turn it into energy, blood, muscle, bone, and the capacity to remain conscious and sharp
. . . the whole ecology we’re part of – the sun and the almost magical ability of plant cells to turn its light into biological energy; the constructive roles of soil and water; the human labor and the care that was taken to cultivate this food; and the lineage of thousands of generations of plants and animals that were intentionally chosen for the purpose of nourishing us.
When we have an experience of just how special this is, eating is no longer just about making the hungry feeling go away or getting a good taste in your mouth. It can be calming and centering. It can be a beautiful spiritual practice. It unites us with our environment.
If you’re ready for a new way of relating to food and how you feed yourself, check out my course, How to Eat. It’s on sale for 60% off right now.
Be well,
Peter
1. https://www.myplate.gov/eat-healthy/dairy
2. https://en.wikipedia.org/wiki/List_of_countries_by_milk_consumption_per_capita
3. https://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy
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I am often asked, “What’s the difference between acupuncture and dry needling?” So, I thought I’d answer the question for everyone in our community who might be interested, and offer some history and science along the way.
“Dry needling” is a term that has grown tremendously in usage over the past decade because it’s a newly adopted practice by many physical therapists. It essentially consists of inserting acupuncture needles into tight muscles. In many states, acupuncturists have fought physical therapists’ attempts to expand their scope of practice to include this procedure. However, physical therapists outnumber acupuncturists by about seven to one, which means stronger state organizations and greater legal power.
Acupuncturists argue that physical therapists are essentially stealing their medicine and calling it something different. In some states physical therapists can practice dry needling with no training in it; in others they typically complete a 55-hour course. By comparison, a licensed acupuncturist generally receives about 500 hours of instruction in the acupuncture-specific portion of their training.
For a few centuries in the West and a couple millennia in China, observers of the human body have known about nodules that occur in tight muscles and are associated with chronic, complex pain patterns. You might just call them “knots.” In the mid-1900s a doctor named Janet Travell coined the term myofascial trigger point to describe this phenomenon. About 90% of them are found at the locations of acupuncture points, which were mapped out on bronze statues at least 1,000 years B.C.E.
Travell explained that myofascial trigger points are irritable regions in our connective tissue (muscle and fascia) that get stuck in a contracted state. They make muscle fibers taut, reducing muscle strength and range of motion, and causing pain, numbness, and other symptoms that often spread to areas far from where they originate. In many cases, what we perceive to be a visceral problem (heart attack, ulcer, migraine, irritable bowel, urinary tract infection, etc.) is actually the symptom of one or more trigger points. I believe trigger points are responsible for most of the physical pain humans experience.
Travell and her colleague David Simons went on to chart the locations and symptoms of trigger points in every major muscle. Travell became John F. Kennedy’s doctor (the first female presidential physician) and his family credited her with saving Kennedy’s political career by curing his back pain through the release of myofascial trigger points.
Travell (and researchers before her) discovered that it’s possible to release a trigger point through a simple procedure she called “ischemic compression.” It basically entails pressing firmly on the center of a trigger point for about half a minute until it softens. Travell’s maps and manual techniques for releasing trigger points were adopted by physical therapists over the following decades. (For what it’s worth, body workers have probably been doing ischemic compression for ages, without calling it ischemic compression.)
Travell also found that she was able to release trigger points by injecting them with numbing agents or saline. However, it emerged that the most effective aspect of this practice wasn’t the injection of fluid, but the mechanical act of probing at the trigger point with a needle. That is, a release could be accomplished even with a “dry” needle, without injecting anything.
Based on this new expression, one could say that all acupuncture is “dry needling.” This is precisely what acupuncturists have always done, although the insertion of needles into these local epicenters of pain is generally just one aspect of an effective acupuncture treatment. What makes an acupuncture treatment holistic (i.e., addressing the whole person) is that the treatment also addresses the underlying mechanisms that led to the surface issue (e.g., stress, diet, digestive problems, more global structural or energetic imbalances, etc.).
In the 1980s, an osteopath and acupuncturist named Mark Seem, founder of Tri-State Acupuncture College in New York City, began integrating Travell’s trigger point maps into traditional acupuncture. He met with Travell and demonstrated his approach. Travell immediately recognized the value of using a much thinner, solid, and springy acupuncture needle (which has a cone-shaped tip), as compared to the hypodermic needles she had been using (which have a scalpel-like hollow beveled tip).
Over the following decades, physical therapists gradually discovered that “dry needling” with acupuncture needles is often a faster and more effective trigger point release method as compared to the various forms of pressure, friction, stretching, exercise, and structural education that have been part of the physical therapists’ palette for their hundred-ish year history. In court cases between acupuncturists and physical therapists, PTs often argue that the insertion of needles into trigger points is a simply an extension of these “manual therapies” described in their scope of practice, and the decision comes down to whether or not the judge agrees.
The other common argument by PTs is that there are many differences between dry needling and acupuncture. In my opinion, having observed PTs doing dry needling and having studied many styles of acupuncture, there’s clear evidence that acupuncturists have been doing everything encompassed in dry needling for a very long time. PTs have insisted that because they know nothing of the acupuncture meridians (energy circuits along which acupuncture points are located), dry needling therefore isn’t acupuncture. But this is like saying that because you haven’t studied anatomy, when you cut into someone with a scalpel you’re not actually doing surgery. Further, there are many systems of acupuncture, several of which don’t utilize meridians.
Enough about the arguments. My purpose isn’t to determine whether or not it’s right for physical therapists to do dry needling, but to clarify the differences in the consumer’s experience.
While acupuncture is great for pain, not all acupuncturists are pain specialists, and most acupuncturists don’t specifically target the trigger points mapped by Travell. If that’s what you’re looking for, it may be worth seeking out an acupuncturist who specializes in pain. Or you might be happy with a skilled physical therapist who does dry needling.
Both acupuncturists and physical therapists run the spectrum from mediocre to brilliantly talented. I have no doubt that there are some masterful PTs out there who get great results doing acupuncture (dry needling) – perhaps better for structural issues than an average-level acupuncturist. I have had patients ask me to “fix” them after a painful dry needling session from a PT that worsened their condition, and I’ve had other patients report good results from dry needling.
If you are skittish about needles, you may not enjoy dry needling from a physical therapist, since it tends to be more intense than the average acupuncture treatment. That said, any form of acupuncture that specifically focuses on releasing trigger points is unlikely to be painless. Regardless of the style of acupuncture I’m performing, I always tell my patients I’m not the person to see if they don’t want to feel anything; I believe a certain degree of sensation is productive.
If you’re someone who cares about how much training your practitioner has received, perhaps it’s meaningful to you that an acupuncturist typically spends ten times as many hours learning their craft than a physical therapist spends learning dry needling. (And virtually all of the acupuncturist’s continuing education will be in acupuncture as well.)
If your primary concern is having your treatments covered by insurance, you’re more likely to get this from a physical therapist. There are some acupuncturists who bill insurance, but more often it will be up to you to submit your receipts and hope for reimbursement.
If it’s important to you that your treatment gets to the root and addresses the whole you, including non-structural issues, you’ll probably be more satisfied with treatment from an acupuncturist. The common experience of “going to acu-land” as some of my patients call it – i.e., becoming deeply relaxed or even having a transcendent experience – isn’t part of the dry needling session. Some would consider the peaceful effect of acupuncture merely a pleasant bonus, but I believe it’s often much more instrumental in the overall outcome than people realize. How often do we stop, rest, and drop all of our concerns? It can be akin to the benefit of a session of deep meditation. The alleviation of stress and a nervous system “reset” is no small thing, especially when stress is the root cause of so much pain.
That said, I find that many patients honestly aren’t concerned with a holistic treatment, and that’s fine. They want a practitioner who will get right into the painful area and work the hell out of it. It might be intense and they might feel beat up afterwards, but there’s a time and place for this kind of work if it’s effective. Personally, I don’t mind receiving aggressive treatments. Occasionally they’ve been miraculous (other times they’ve left me temporarily crippled with no relief). And of course, if the pain itself is one’s primary stressor, one could argue that getting rid of the pain should be a higher priority than alleviating stress (though we don’t have to choose one or the other). In my experience it’s a slight minority of acupuncturists who work this way, while it’s quite common for a physical therapist.
Whew! That was a long-winded exploration of this topic. I thought about removing parts of this article to shorten it, but having had this conversation so many times, I’ve found that many people are curious about all the facets of this subject. I hope I offered some clarity.
Be well,
Dr. Peter Borten
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